Originally printed in IndyStar: \u201cThey were young. They thought they had time. Then they nearly died of liver disease.\u201d By Shari Rudavsky, February 18, 2020.<\/em><\/p>\n

Although Rachel Martin would never deny she had a drinking problem, she figured years would pass before it would take a toll on her health. After all, she had not yet hit 40 and she had managed to eke out two years of complete sobriety about a decade ago.<\/p>\n

Even when she was drinking, she would hit the bottle hard for three weeks but then go cold turkey for a week.<\/p>\n

So when Martin started feeling off about a year and a half ago, she tried to ignore the symptoms. She lost her appetite, her skin itched, and as she put it, she lost her waist as fluid accumulated in her abdomen. For four months\u00a0she continued to drink, but in mid-March 2019, she decided she was done.<\/p>\n

The next day she finally went to the doctor and found out she had cirrhosis of the liver, something that did not surprise her, given her internet-aided self-diagnosis.<\/p>\n

What did surprise her, however, was what her doctor said: If she did not stop drinking she might die within a month. Even if she did quit, she might not make it three months.<\/p>\n

\u201cYou know it\u2019s bad for you, you know it\u2019s not healthy at all whatsoever, but you think, ‘Oh, I have no family history of this,’ \u201d said the Bloomington resident, who is now 39. \u201cI know people that drink more than I do, and they\u2019re fine. I have years before I have to worry about this.\u201d<\/p>\n

Doctors are seeing more patients like Martin, people in their 20s and 30s with symptoms of acute liver disease related to alcohol consumption. The National Institute on Alcohol Abuse and Alcoholism published\u00a0a study in January<\/a>\u00a0that found that from 1999 to 2017 the number of alcohol-related deaths per year doubled, rising from 35,914 to 72,558. Just under a third of those resulted from liver disease.<\/p>\n

Similarly, a\u00a0study in the British Medical Journal\u00a0<\/a>published in 2018 also noted a dramatic increase in deaths in the United States from cirrhosis from 1999 to 2016. In that time period, people ages 25 to 34 saw the highest increase.<\/p>\n

Indiana came in No. 4 in the list of states with the highest average annual change in deaths stemming from cirrhosis.<\/p>\n

\u201cThere is an epidemic of alcoholism and alcohol use disorder that I think is hiding behind the opioid crisis,\u201d said Dr. Naga Chalasani, head of hepatology at\u00a0Indiana University\u00a0Health<\/a>. \u201cAlcohol consumption has risen in this country. …\u00a0Everything is sort of going in the wrong direction. There are more people drinking, and the people who drink are drinking more.\u201d<\/p>\n

Many of those who wind up requiring care do not fit the stereotypical image of an alcoholic. They may be highly productive individuals who work and have families until suddenly they find themselves facing an acute health crisis\u00a0brought on by alcohol-related liver disease, such as acute hepatitis or cirrhosis.<\/p>\n

The trend is particularly pronounced in middle-aged women, where studies suggest that high-risk drinking is the highest it has ever been, Chalasani said.\u00a0A 2019 study\u00a0<\/a>by University of Michigan researchers that looked at more than 100 million Americans with private insurance found a 50% increase in the prevalence of alcohol-related cirrhosis in women from 2009 to 2015.<\/p>\n

The people getting sick are not necessarily the people you might expect.<\/p>\n

How much alcohol is too much<\/strong><\/p>\n

Several factors likely contribute, experts say. The alcohol industry invests heavily in marketing. Many people who drink start in college and just continue into young adulthood and beyond. Many social events seamlessly incorporate the consumption of alcohol, from women\u2019s nights out to football parties to business dinners.<\/p>\n

Doctors are seeing more patients with alcoholic-related liver disease who have no trouble functioning day to day.<\/p>\n

\u201cThey are people who consume alcohol on\u00a0a\u00a0moderate basis chronically enough to be harmful to them, and they didn\u2019t really expect it to be that harmful,”\u00a0said Dr. Mazen Alsatie, a gastroenterologist and hepatologist with\u00a0Ascension St. Vincent<\/a>.<\/p>\n

“An almost daily basis of a moderate amount of alcohol can be much more harmful than a binge drinker who drinks once a month and then quits.\u201d<\/p>\n

Conventional wisdom used to hold that moderate drinking \u2014 a glass or two a day for women and up to three drinks for men \u2014 might actually benefit health. Studies also have\u00a0touted the health benefits of wine. But experts have started to dial back such endorsements of alcohol, especially after\u00a0a controversial 2018 study\u00a0<\/a>in The Lancet even suggested that no amount alcohol is safe.<\/p>\n

The\u00a0Centers for Disease Control and Prevention\u00a0<\/a>recommends that alcohol be consumed in moderation, which according to the U.S. Dietary Guidelines consists of no more than one drink a day for women and two for men.<\/p>\n

Part of the problem may be that our notion of what counts as \u201cone drink\u201d has shifted over time. The medical literature considers a 5-ounce glass of wine as one serving of alcohol, said Lindsay Yoder, an IU Health physician assistant who specializes in treating people with liver disease. A single glass at a bar or restaurant can contain two to three times that amount. A highball glass filled with whiskey contains two servings.<\/p>\n

Then\u00a0there\u2019s the conventional wisdom that alcohol-related disease does not strike people in their prime of life.<\/p>\n

\u201cThey think it\u2019s an older, white guy\u00a0who has cirrhosis, he\u2019s been sitting around in a bar after work for decades,\u201d said Yoder, who runs a weekly outpatient clinic where she helps care for people with liver disease. \u201cI see a really high percentage of patients in that clinic that are young. …\u00a0It\u2019s just devastating.\u201d<\/p>\n

Of course, not everyone who drinks winds up with health issues, which is why the problem is so confusing for the people who do.<\/p>\n

Some can drink, some can’t<\/strong><\/p>\n

Jordon Mattingly admits in retrospect he probably drank too much, but it was an occupational hazard. For the past three years he has\u00a0tended bar. Rarely did he wind up so inebriated he couldn\u2019t drive, but he did down more than half of a fifth of vodka a day.<\/p>\n

In October he started having acute stomach pains, and he went to the hospital in Evansville, where he lives. The doctors diagnosed him with alcoholic liver hepatitis and cirrhosis.<\/p>\n

Eventually he grew so sick that the Southern Indiana hospital which was treating him transferred him to IU Health University Hospital. In three and a half weeks, he lost 40 pounds and was deathly ill when he arrived in Indianapolis.<\/p>\n

Now 28, Mattingly never thought his drinking could\u00a0jeopardize\u00a0his health. His doctors explained to him that everyone’s liver handles alcohol differently.<\/em><\/strong><\/p>\n

\u201cSome people can handle it;\u00a0some people can\u2019t,\u201d he said.\u00a0\u201cBut I guess I\u2019m one that can\u2019t.\u201d<\/p>\n

The question of why one person can drink heavily with no repercussions while another will drink even less and wind up in the hospital with alcohol-related liver disease plagues the experts.<\/p>\n

One theory is tied to the rise in obesity.\u00a0That trend has led rates of non-alcoholic liver disease to skyrocket to as much as a third of the U.S.\u00a0population.\u00a0Consuming greasy, fatty foods contributes to that disorder, Alsatie said.<\/p>\n

So even people who are not obese but who have poor diets and who consume moderate amounts of alcohol may be inadvertently harming their liver in two different ways.<\/p>\n

Counter to conventional wisdom, then, a heavier person who has two drinks a day may be more predisposed to acute liver-related disease than a slimmer person who has three drinks a day.<\/p>\n

Genetics also may help explain the discrepancy. Experts know, for instance, that for some women just two to three drinks a day for four to five years can lead to alcohol-related liver disease. On average men can have one more than that, Chalasani said, but most people are not aware of the risk.<\/p>\n

\u201cThere\u2019s just a lack of understanding that you really don\u2019t need to drink a bottle to get into trouble,\u201d Chalasani said. \u201cIt\u2019s just if you have the wrong set of genes you can get into trouble. I don\u2019t think people appreciate that. …\u00a0If you just ask people, even highly educated people, most don\u2019t realize that two drinks a day is problematic.\u201d<\/p>\n

For those with a genetic predisposition, that seemingly innocuous level of alcohol can lead to serious health problems. About a third of people who drink heavily go on to develop alcoholic hepatitis, a condition in which the cells of the liver become inflamed, according to the\u00a0American Liver Foundation<\/a>. Between 10% and\u00a020% of heavy drinkers develop cirrhosis, in which scar tissue in a damaged liver replaces healthy tissue.<\/p>\n

In the early stages of liver disease, the condition can be reversed as long as the person stops drinking completely. An ultrasound of the liver can reveal how much damage a person\u2019s liver has sustained, Alsatie said. If there is minimal to moderate damage, stopping drinking will allow the liver to recover.<\/p>\n

But liver disease can be silent, so many people have no clue of the damage they are doing until the disease has advanced and they develop symptoms such as jaundice, nausea, vomiting, or abdominal pain and swelling.<\/p>\n

\u201cThat\u2019s the trickiest part about the liver. It is a dumb organ,\u201d Yoder said. \u201cIt doesn\u2019t complain about anything until it\u2019s too late.\u201d<\/p>\n

Only hope a liver transplant<\/strong><\/p>\n

Like many people, Martin started with social drinking. In her mid-20s, she began turning to alcohol more as a coping mechanism. But even then she would have patches where she gave it up entirely, detoxing herself.<\/p>\n

\u201cI would drink hard for one week, don\u2019t drink for three weeks,\u201d she said. \u201cI knew it was affecting my life, but it\u2019s a really easy pattern to fall into.\u201d<\/p>\n

Each time, though, she would eventually return to drinking socially, which would then open the door to overindulging. At one point she went to an inpatient rehab. But once more after a few months, she started drinking again.<\/p>\n

A few years ago, she suffered a loss that prompted her once more to start drinking heavily until that day last March in her doctor\u2019s office. The disease had taken such a toll that she spent the next five months in and out of the hospital. Her liver was so damaged, her kidneys shut down and she had to go on dialysis.<\/p>\n

Her only hope was a transplant.<\/p>\n

Until recently Martin would not have been a candidate for a transplant, given her drinking history. But transplant centers have been relaxing their criteria, faced with the uptick in younger people. A transplant can afford years of life for someone not yet in middle age who stays sober. In the past half year or so, IU Health has started considering patients like Martin on a case by case basis, Chalasani said.<\/p>\n

During the process, Martin did not tell many people about her medical travails. The three friends she did tell had little surprise. When she mentioned her liver transplant, often people would say that their cousin or dad or uncle had a transplant, too.<\/p>\n

\u201cThe thing about alcohol-related liver disease, it\u2019s a dirty little secret,\u201d Martin said. \u201cIt\u2019s embarrassing because you have done this to yourself.\u201d<\/p>\n

Since her transplant in August, Martin hasn\u2019t had a drink, and she has no intention of ever drinking again. Her life, she said, is far better without alcohol.<\/p>\n

Mattingly agrees. He hasn\u2019t had a drink since October. He\u00a0still is recovering, and his doctors have told him to give it time. He\u2019s hoping his youth will be on his side.<\/p>\n

\u201cThey think that because I\u2019m so young that my liver will rejuvenate to a certain extent,\u201d he said. \u201cI just don\u2019t ever want to go through it again.\u201d<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Originally printed in IndyStar: \u201cThey were young. They thought they had time. Then they nearly died of liver disease.\u201d By Shari Rudavsky, February 18, 2020. Although Rachel Martin would never deny she had a drinking problem, she figured years would … Continued<\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_links_to":"","_links_to_target":""},"categories":[17],"tags":[],"acf":[],"_links":{"self":[{"href":"https:\/\/pgdf.org\/wp-json\/wp\/v2\/posts\/3397"}],"collection":[{"href":"https:\/\/pgdf.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pgdf.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pgdf.org\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pgdf.org\/wp-json\/wp\/v2\/comments?post=3397"}],"version-history":[{"count":1,"href":"https:\/\/pgdf.org\/wp-json\/wp\/v2\/posts\/3397\/revisions"}],"predecessor-version":[{"id":3399,"href":"https:\/\/pgdf.org\/wp-json\/wp\/v2\/posts\/3397\/revisions\/3399"}],"wp:attachment":[{"href":"https:\/\/pgdf.org\/wp-json\/wp\/v2\/media?parent=3397"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pgdf.org\/wp-json\/wp\/v2\/categories?post=3397"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pgdf.org\/wp-json\/wp\/v2\/tags?post=3397"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}